Arcadi García Alberola

Hospital Universitario Virgen de la Arrixaca, Murcia, Murcia, Spain

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Publications (80)199.61 Total impact

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    ABSTRACT: Aims Cryoballoon (CB) ablation with the second-generation cryoballoon (CBG2) seems to be more effective than its predecessor [first-generation cryoballoon (CBG1)], but phrenic nerve palsies were observed more frequently. The aim of this study was to compare the safety and efficacy of CBG1 and CBG2 in a substudy of the prospective multicentre, multinational FREEZE Cohort Study. Methods and results Periprocedural data were analysed, and a total of 532 patients with paroxysmal atrial fibrillation (AF) were examined (n = 224 for CBG1 and n = 308 for CBG2). Procedure time decreased significantly from 149 to 130 min when comparing CBG1 with CBG2 (P < 0.0001), and pulmonary vein isolation (PVI) was achieved in 97.8 and 97.6% of PVs with CBG1 and CBG2 (P = 0.77), respectively. The need for dual-balloon usage within a procedure dropped (20.1 vs. 9.0%, P < 0.001), and the fluoroscopy time was reduced when operating the CBG2. Atrial fibrillation recurrence rates until discharge were similar (5.0 vs. 5.8%, P = 0.69). Comparable low rates of major complications were observed with both CBs, and there was a non-significant trend for more phrenic nerve palsies. Conclusion Second-generation cryoballoon demonstrated a high rate of acute PVI in a significant faster procedure, which also utilized less radiation exposure and less dual-balloon usage during an average procedure. The safety profile remains favourable with a non-significant trend for more phrenic nerve palsies. If the enhancements lead to a higher clinical benefit has to be determined. The 1-year outcome data from the ongoing FREEZE Cohort Study comparing radiofrequency and CB ablation will shed some light on that issue.
    Full-text · Article · Jul 2014 · Europace
  • M.S. Martínez · P.P. Verdú · A.G. Alberola · M.V. Chávarri
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    ABSTRACT: Paroxysmal supraventricular tachycardias are fast and usually regular rhythms that require some structures above the bifurcation of the His bundle to be continued, and often are caused by reentrant circuit. The 3 most common types are: atrioventricular nodal reentrant, tachycardias mediated by an accessory pathway and atrial tachycardias. They are characterized by a considerable heterogeneity of clinical presentations (ranging from almost asymptomatic forms to those producing a certain disability). They usually occur in people without structural heart disease, and their prognosis is generally benign. Differential diagnosis with other regular tachycardia with a narrow QRS complex is to be made, and electrophysiological study is sometimes necessary for an accurate diagnosis. The treatment of choice for symptomatic patients is generally catheter ablation.
    No preview · Article · Sep 2013
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    ABSTRACT: Las taquicardias de QRS estrecho son una entidad clínica frecuente, repetitivas, y una de las patologías cardiovasculares más relevantes en los Servicios de Urgencias hospitalarias y extrahospitalarias. Aunque lo más frecuente es una aceptable tolerancia clínica, en determinados pacientes puede producir inestabilidad hemodinámica y precipitar o empeorar patologías subyacentes (como insuficiencia cardiaca o cardiopatía isquémica). Las opciones terapéuticas disponibles presentan una elevada efectividad cuando se aplican bien, por lo que es fundamental llegar a un correcto diagnóstico clínico y electrocardiográfico que permita elegir el tratamiento más apropiado. En las siguientes páginas se expone un breve protocolo diagnóstico-terapéutico de este tipo de arritmias, con el objetivo de familiarizar al lector con los criterios diferenciales básicos entre los distintos tipos de taquicardia de QRS estrecho y, en función de los mismos, poder elegir el tratamiento más efectivo.
    No preview · Article · Sep 2013
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    ABSTRACT: Background: Sports activity was associated with an increased risk of sudden cardiac death (SCD) in adolescents and young adults with undiagnosed cardiomyopathies or channelopathies. It is estimated that one in 1000 athletes may be affected. The present study sought to determine the percentage of patients diagnosed with familial cardiopathies that do physical exercise regularly, their clinical characteristics, and follow-up through a specialized consultation. Methods: A prospective observational study was designed. 1128 consecutive patients (age 49±19, 418 (37%) women) from 765 families that satisfied diagnostic criteria for cardiomyopathy or channelopathy were included. Age of diagnosis, clinical characteristics, and electrocardiographic and echocardiographic parameters were collected. Rate of events was determined in both groups: SCD; resuscitated sudden cardiac death (RSCD); and implantable cardioverter defibrillator (ICD) discharge. Results: 85 athletes (7,5%) were identified. The mean age at diagnosis was significantly lower in the group of patients that practiced sports (31,5±15 years vs 45,6±20 years; p<0,001). Among patients diagnosed with hypertrophic cardiomyopathy, athletes group presented a lower thickness of ventricular septum (median 15mm, range 14 to 20mm vs 19mm, range 16 to 22mm; p=0,001). Left ventricular ejection fraction (LVEF) in patients diagnosed with idiopathic dilated cardiomyopathy was higher in the group of athletes (mean 51,1±5,6% vs 35,4±13,6%; p<0,001). Four patients that practiced sports routinely had events: 3 SCD and one RSCD; while in the group of non-athlete patients, 64 of them presented events: 23 SCD, 26 RSCD, and 15 ICD discharges. There were no significant differences in the development of events between the two groups. Conclusions: A significant proportion of patients with familial cardiopathies practice sport regularly. Diagnosis of heart disease was earlier in the group of athletes. In this group, the thickness of ventricular septum among patients with hypertrophic cardiomyopathy was lower and patients with idiopathic dilated cardiomyopathy had higher LVEF than in the group of non-athletes. There were no differences between both groups in the development of events. Further studies are required to understand the relationship between sport and the development of adverse events in patients diagnosed with familial cardiopathies.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Background: Due to the underlying muscle disease, patients with hypertrophic cardiomyopathy (HCM) have a high risk for life-threatening arrhythmias and may have an increased QT interval. However, the independent contribution of the long QT interval to the arrhythmic risk in this population is not well known. Purpose: The purpose of this study was to investigate the role of increased long QT corrected (QTc) interval in the development of malignant arrhythmias in a population of patients with hypertrophic cardiomyopathy (HCM), and also the relationship between QTc and clinical and echocardiographic variables in these patients. Methods: We studied 312 patients with HCM (118 females, age at diagnosis 47±19, maximal left ventricular wall thickness (MLVWT) 19±6mm]. A clinical, an electrocardiographic and an echocardiographic evaluation were carried out in each of them. Results: In this group of patients, 31% (n=96) had prolonged QT interval in the electrocardiogram, defined as QTc value >460ms, being the mean value of the QTc in this population of 447ms±32ms. Of these patients, 244 (78%) underwent to 24-hours electrocardiogram monitoring, presenting 23% of them (n=56) at least one episode of non-sustained ventricular tachycardia (NSVT) on Holter. However, no significant differences in QTc interval between both groups were shown (446±34ms in patients with documented NSVT vs 445±30ms in idividuals with no evidence of NSVT on Holter; p = 0.6). There were no statistically significant differences between the presence/development of atrial fibrillation or syncope and prolongated QTc interval. Finally, there was a weak but significant direct linear relationship between QTc and maximal left ventricular wall thickness (MLVWT) (r2=0.07 p<0.0001). Conclusions: QT prolongation was present in 31% of the patients with HCM studied. This study corroborates the findings of previous publications that the QTc interval is related with the degree of cardiac hypertrophy, and adds that there is no significant relationship with the presence of NSVT on 24h Holter, atrial fibrillation or syncope.
    No preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Introducción y objetivos. El desfibrilador implantable mejora la supervivencia en pacientes postinfarto de miocardio con a) fracción de eyección = 0,30 y b) fracción de eyección = 0,40, taquicardias ventriculares no sostenidas y arritmias ventriculares inducibles. Estos criterios no han sido evaluados en el contexto de la angioplastia primaria. El objetivo del estudio es evaluar el impacto de ambos criterios en las indicaciones de desfibrilador en pacientes con infarto revascularizados con angioplastia primaria. Pacientes y método. Se estudió a 102 pacientes postinfarto (80 varones; edad, 63,6 ± 11,5 años) incluidos en un programa regional de angioplastia primaria. Se realizó un registro Holter de 24 h entre las semanas 2 y 6 postinfarto, al mes, y se estimó la fracción de eyección por ecocardiografía practicando estimulación ventricular programada en el grupo con fracción de eyección = 0,40 y taquicardia ventricular no sostenida. Resultados. Un total de 22 pacientes (21,6%; intervalo de confianza [IC] del 95%, 13,6-29,6) presentaron taquicardia ventricular no sostenida en el Holter. Seis de ellos tuvieron fracción de eyección = 0,40, siendo inducibles 2 de 5 en el estudio electrofisiológico. La fracción de eyección fue = 0,30 en 3 pacientes, ninguno de los cuales presentó taquicardia ventricular no sostenida. En total, 5 pacientes (4,9%) tuvieron indicación de desfibrilador aplicando alguno de los 2 criterios. Conclusiones. La prevalencia de taquicardia ventricular no sostenida en pacientes con infarto tratados con angioplastia primaria es elevada. Sin embargo, la mayoría tiene una función ventricular conservada, por lo que la prevención primaria con desfibrilador estaría indicada en un 5% aproximadamente utilizando los criterios evaluados en este estudio.
    No preview · Article · Jul 2013 · Revista Espa de Cardiologia
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    ABSTRACT: Arrhythmia Rounds. A 39-year-old woman with no structural heart disease and frequent episodes of sudden onset palpitations was referred for the electrophysiological study. During the study, a slightly irregular narrow QRS tachycardia with AV dissociation was repeatedly induced and spontaneously terminated. Apparently, irregular cycles and termination of the tachycardia were related to the dissociated sinus rhythm: atrial depolarizations timed when the AV junction was refractory were able to reset the tachycardia, while early atrial depolarizations caused its termination. This observation was enough to diagnose the tachycardia mechanism in our case. (J Cardiovasc Electrophysiol, Vol. pp. 1-3).
    No preview · Article · Oct 2012 · Journal of Cardiovascular Electrophysiology
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    ABSTRACT: Introduction Heart failure is a significant and growing health problem. To enable a preventative health care system in heart failure, a move is required from the current, intermittent episodical treatment to continuous and ubiquitous access to medical excellence. Home telemonitoring systems that monitor vital body signs and symptoms with wearable technology, have been proposed to enhance treatment and anticipation of adverse events in heart failure patients (decompensation). Aims and objectives We investigated whether the data recorded in a home telemonitoring system using innovative sensors had predictive value in detecting heart failure related events. Methods In the MyHeart observational clinical trial, 148 heart failure patients were followed daily for up to one year using an innovative telemonitoring system recording symptoms questionnaires, basic parameters such as body weight and blood pressure, as well as advanced information provided by a bed sensor monitoring night heart rate and activity and a thorax bioimpedance (BIM) device, designed to monitor fluid accumulation in the lungs. The area under the receiver operator characteristic curve (AUC) was used to evaluate the predictive value for heart failure related events of single and combined telemonitoring measurements. Results The telemonitoring system including innovative sensors was rated positively by the patients, which is further supported by the reasonable compliance rates (>65%) measured. The most predictive variables 14 days preceding an event were thoracic bioimpedance (area under the curve of 0.70), night breathing rate and some symptoms. The initial multiparametric analysis achieved a mean accuracy of 80.6% but would require more data to confirm its generalisation ability. Conclusions The measurements performed during the MyHeart trial with 148 patients and 12 months’ follow-up provided evidence supporting the development of predictive algorithms of decompensation to support heart failure management at home. An innovative wearable monitor of thoracic congestion by means of bioimpedance was tested and showed the highest predictive value for heart failure decompensation among a large set of monitored vital signs and symptoms.
    Preview · Article · Jun 2012 · International journal of integrated care
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    ABSTRACT: Cardiomyopathy and channelopathy are major causes of sudden death (SD). The little information available on the context in which SD occurs has come from only a few referral centers. The objective was to investigate the circumstances surrounding SD in families with inherited heart disease. The study included 152 SD patients (mean age 43+/-19 years) from 103 families. The reasons for inclusion were resuscitated SD in 7%, recent SD in 8%, and a diagnosis of cardiomyopathy or channelopathy in a living relative in 72%. Also, 13% were athletes. Family trees were constructed and each death's circumstances were recorded. Autopsy and medical records were reviewed. Overall, 18% of SDs occurred during physical exercise, 32% during normal daily activities, and 37% during rest or sleep. There was a significant association between male sex and SD: 111 males (73%) vs. 41 females (27%; P=.03). Exercise-related SD was associated with young age (P=.01). The percentage of SDs associated with exercise, stress or normal daily activities was significantly greater with cardiomyopathy than channelopathy (61% vs. 41%; P=.057). All athletes were male and the majority died during exercise (50% vs. 11% of non-athletes; P=.0002). Patients with Brugada syndrome had the highest percentage of SDs during rest or sleep (i.e. 47%). No clear trigger could be identified in 33%. SD was common in inherited heart disease, which accounted for a significant number of cases. Males clearly predominated over females (ratio 3:1) among SD cases (irrespective of pathological type). Most SDs occurred during exercise or normal daily activities in cardiomyopathies and during rest or sleep in channelopathies. The percentage of exercise-related SDs (i.e. 18%) was higher than expected.
    Full-text · Article · Mar 2010 · Revista Espa de Cardiologia
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    ABSTRACT: Introduction and objectives Cardiomyopathy and channelopathy are major causes of sudden death (SD). The little information available on the context in which SD occurs has come from only a few referral centers. The objective was to investigate the circumstances surrounding SD in families with inherited heart disease. Methods The study included 152 SD patients (mean age 43±19 years) from 103 families. The reasons for inclusion were resuscitated SD in 7%, recent SD in 8%, and a diagnosis of cardiomyopathy or channelopathy in a living relative in 72%. Also, 13% were athletes. Family trees were constructed and each death's circumstances were recorded. Autopsy and medical records were reviewed. Results Overall, 18% of SDs occurred during physical exercise, 32% during normal daily activities, and 37% during rest or sleep. There was a significant association between male sex and SD: 111 males (73%) vs. 41 females (27%; P=.03). Exercise-related SD was associated with young age (P=.01). The percentage of SDs associated with exercise, stress or normal daily activities was significantly greater with cardiomyopathy than channelopathy (61% vs. 41%; P=.057). All athletes were male and the majority died during exercise (50% vs. 11% of non-athletes; P=.0002). Patients with Brugada syndrome had the highest percentage of SDs during rest or sleep (i.e. 47%). No clear trigger could be identified in 33%. Conclusions SD was common in inherited heart disease, which accounted for a significant number of cases. Males clearly predominated over females (ratio 3:1) among SD cases (irrespective of pathological type). Most SDs occurred during exercise or normal daily activities in cardiomyopathies and during rest or sleep in channelopathies. The percentage of exercise-related SDs (i.e. 18%) was higher than expected.
    No preview · Article · Mar 2010 · Revista Espa de Cardiologia
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    ABSTRACT: Digital signal processing algorithms for cardiac recordings have been paid much attention in recently disclosed patents. In this second part of our review of the state-of-art patents, systems for sudden cardiac death prediction, as well as for apnea analysis, are summarized. Advanced digital signal processing algorithms for cardiac electric signals are specifically reviewed, including independent component decompositions, and nonlinear methods (chaos, fractals, and entropies). Finally, systems aiming to solve the inverse problem in electrocardiography are presented. Concluding remarks on these systems and on the whole review are discussed.
    Full-text · Article · Jan 2010 · Recent Patents on Biomedical Engineering
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    ABSTRACT: Cardiac electric signals are currently the most informative source about the heart rhythm and its disorders, and hence, the use of adequate digital signal processing techniques is necessary to yield reliable diagnostic parameters, either to the clinician or to automatic monitoring systems. A number of systems have been patented during the last years, which are grouped in this review according to their application scope. In this first part, techniques for electrocardiogram and intracardiac electrogram filtering, and for feature extraction, are first examined, then patents on arrhythmia analysis are then summarized. The wide number of basic systems for cardiac signal processing analysis that have been disclosed indicates that this field represents a main scenario in the near and middle future of cardiac health.
    Full-text · Article · Jan 2010 · Recent Patents on Biomedical Engineering
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    Arcadi García Alberola · Miguel Alvarez López · Enrique Rodríguez Font
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    ABSTRACT: Introducción. Se detallan los resultados (éxito y complicaciones) del Registro Español de Ablación del año 2004 elaborado por la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología por cuarto año consecutivo. Material y método. La recogida de datos se llevó a cabo mediante 2 sistemas: de forma retrospectiva cumplimentando un cuestionario que fue enviado desde la Sección de Electrofisiología y Arritmias a los laboratorios de electrofisiología y, de forma prospectiva, a través de una base de datos común. La elección de una u otra fue voluntaria por parte de cada uno de los centros. Resultados. Participaron voluntariamente 36 centros. El número de procedimientos de ablación analizado fue de 4.147, con una media de 115 ± 66 procedimientos por centro. Los 3 sustratos más frecuentemente abordados fueron la taquicardia intranodal (32%), las vías accesorias (25%) y la ablación del istmo cavotricuspídeo (23%), con un porcentaje de éxito del 98, el 89 y el 91%, respectivamente. El porcentaje global de éxito fue del 90%, el de complicaciones mayores del 1,5% y el de mortalidad del 0,07%. Conclusiones. Aun con una participación ligeramente inferior a la de años anteriores, el volumen de ablaciones recogidas (> 4.000) y los resultados concordantes con los registros precedentes confirman la validez y la consistencia de nuestro Registro.
    Preview · Article · Nov 2009 · Revista Espa de Cardiologia
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    ABSTRACT: The mechanisms responsible for the maintenance and termination of ventricular fibrillation (VF) are poorly understood. The aim of this study was to compare the spectral characteristics of the electrical signal during sustained and non-sustained VF in patients with an implantable cardioverter-defibrillator. The study included 51 patients who had had at least one episode of sustained VF (i.e., duration >5 s and requiring shock administration) and non-sustained VF (i.e., duration >3 s and spontaneously terminated) that were recorded by the device set in a unipolar configuration. Spectral analysis of the first 3 s of each episode was performed. The dominant frequency was higher in sustained VF (4.6+/-0.7 Hz) than in non-sustained VF (4.3+/-0.6 Hz; P=.01), while the other parameters were similar. Although the spectral characteristics of sustained and non-sustained VF were similar, differences were observed during the first 3 s that could be used in algorithms for the early detection of non-sustained VF.
    Full-text · Article · Jun 2009 · Revista Espa de Cardiologia
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    ABSTRACT: The mechanisms responsible for the maintenance and termination of ventricular fibrillation (VF) are poorly understood. The aim of this study was to compare the spectral characteristics of the electrical signal during sustained and non-sustained VF in patients with an implantable cardioverter-defibrillator. The study included 51 patients who had had at least one episode of sustained VF (i.e., duration >5 s and requiring shock administration) and non-sustained VF (i.e., duration >3 s and spontaneously terminated) that were recorded by the device set in a unipolar configuration. Spectral analysis of the first 3 s of each episode was performed. The dominant frequency was higher in sustained VF (4.6 ± 0.7 Hz) than in non-sustained VF (4.3 ± 0.6 Hz; P=.01), while the other parameters were similar. Although the spectral characteristics of sustained and non-sustained VF were similar, differences were observed during the first 3 s that could be used in algorithms for the early detection of nonsustained VF.
    Full-text · Article · Jun 2009 · Revista Espa de Cardiologia
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    ABSTRACT: The mechanisms responsible for the maintenance and termination of ventricular fibrillation (VF) are poorly understood. The aim of this study was to compare the spectral characteristics of the electrical signal during sustained and non-sustained VF in patients with an implantable cardioverter-defibrillator. The study included 51 patients who had had at least one episode of sustained VF (ie, duration >5 s and requiring shock administration) and non-sustained VF (ie, duration >3 s and spontaneously terminated) that were recorded by the device set in a unipolar configuration. Spectral analysis of the first 3 s of each episode was performed. The dominant frequency was higher in sustained VF (4.6 [0.7] Hz) than in non-sustained VF (4.3 [0.6] Hz; P=.01), while the other parameters were similar. Although the spectral characteristics of sustained and non-sustained VF were similar, differences were observed during the first 3 s that could be used in algorithms for the early detection of non-sustained VF. Análisis espectral de la fibrilación ventricular sostenida y no sostenida en portadores de desfibrilador implantable Los mecanismos de mantenimiento y finalización de la fibrilación ventricular (FV) son poco conocidos. El objetivo del estudio es comparar las características espectrales de la señal eléctrica de la FV sostenida y no sostenida en pacientes portadores de desfibrilador implantable. Se incluyó a 51 pacientes con al menos un episodio de FV sostenida (de más de 5 s y que pre-cisara choque) y no sostenida (de más de 3 s y termi-nación espontánea) registrados por el dispositivo en configuración monopolar. Se realizó un análisis espec-tral de los primeros 3 s de cada episodio. La frecuencia dominante fue mayor en las FV sostenidas (4,6 ± 0,7 frente a 4,3 ± 0,6 Hz en las no sostenidas; p = 0,01), y los demás parámetros fueron similares. Durante los primeros 3 s, si bien las características espectrales son parecidas, hay diferencias utilizables en algoritmos de detección precoz de FV no sostenida.
    Full-text · Article · Jan 2009
  • P. Peñafiel Verdú · A. García Alberola · M. Valdés Chávarri

    No preview · Article · Dec 2008 · Medicine - Programa de Formación Médica Continuada Acreditado
  • P. Peñafiel Verdú · A. García Alberola · M. Valdés Chávarri

    No preview · Article · Jan 2008

  • No preview · Article · Nov 2007 · Journal of Electrocardiology

  • No preview · Article · Jun 2005 · Medicine - Programa de Formación Médica Continuada Acreditado

Publication Stats

204 Citations
199.61 Total Impact Points

Institutions

  • 2001-2014
    • Hospital Universitario Virgen de la Arrixaca
      • Departamento de Cardiología
      Murcia, Murcia, Spain
  • 2009
    • King Juan Carlos University
      • Signal and Communications Theory
      Мостолес, Madrid, Spain
  • 2004-2009
    • Sociedad Española de Cardiología
      Madrid, Madrid, Spain
  • 1998
    • University of Murcia
      Murcia, Murcia, Spain
  • 1991
    • Facultad de Medicina
      Madrid, Madrid, Spain
    • Port of Spain General Hospital
      City of Port-of-Spain, City of Port of Spain, Trinidad and Tobago